Impact of Tumor Burden and Cardiac Factors on Survival After Valve Surgery for Carcinoid Heart Disease.

Objective: To evaluate the association of preoperative cardiac status and tumor characteristics with long-term survival after valve surgery for carcinoid heart disease (CHD).

Methods: A retrospective review was conducted of patients surgically treated for CHD at our institution between 2000 and 2023.

Results: A total of 168 patients (median age, 63.2 years; 48.2% women) with CHD who underwent valvular surgery from 2000 to 2023 were included. The primary site of the neuroendocrine tumor was the small bowel in 89.3% of the patients. All patients had liver metastasis, with 31% of the patients having more than 75% involvement of the liver parenchyma, and 28% had bone metastases. Tricuspid valve replacement was performed in 98.2%, pulmonary valve replacement in 79.2%, and both in 78.6%. Operative mortality was 6%. After a median follow-up of 8.3 years, median survival was 2.9 (2.2 to 4.1) years (5-year survival was 34.1% for the overall cohort, 16.2% for patients with more than 75% liver metastasis, and 13.1% for those with bone metastases). Independent predictors of long-term mortality included more than 75% metastatic liver involvement (hazard ratio [HR], 1.5; 95% CI, 1.1 to 2.3), presence of bone metastases (HR, 2.0; 95% CI, 1.2 to 3.0), New York Heart Association class III or IV (HR, 2.3; 95% CI, 1.5 to 3.6), and severe right ventricular dysfunction (HR, 3.3; 95% CI, 1.4 to 7.6).

Conclusion: Valve surgery in patients with CHD relieves symptoms of right-sided heart failure. However, long-term survival is limited in patients with significant metastatic liver burden, bone metastases, or severe right ventricular dysfunction, underscoring the importance of incorporating these prognostic factors into preoperative risk assessment.